Postoperative Chemotherapy Does Not Improve Survival In Gastric Cancer Patients, Study Suggests

Postoperative Chemotherapy Does Not Improve Survival In Gastric Cancer Patients, Study Suggests

* w w w .sciencedaily . com /releases/2008/03/080311215911.htm

Postoperative Chemotherapy Does Not Improve Survival In Gastric Cancer
Patients, Study Suggests

ScienceDaily (Mar. 11, 2008) — The use of combination chemotherapy
following surgery did not improve survival in patients with gastric
cancer, according to a randomized clinical trial.

The only potentially curative therapy currently available for
non-metastatic gastric cancer is surgery. Recent studies have suggested
that a combination of cisplatin, epirubicin, 5-fluorouracil and leucovorin
(PELF) improves outcome in patients with metastatic gastric cancer.

To test the PELF combination in patients with localized disease, Francesco
Di Costanzo, M.D., of the University Hospital Careggi in Florence, Italy,
and colleagues in the Italian Oncology Group for Cancer Research conducted
a randomized controlled trial in which 258 patients were treated with
surgery or surgery followed by chemotherapy.

With a median follow-up of 72.8 months, there was no significant
difference in disease-free survival or overall survival between the two
trial arms. Specifically, 47.7 percent of the patients treated with
chemotherapy had progressive disease compared with 51.6 percent of
patients in the control arm. Overall survival was similar; at the end of
the follow-up period, 47 percent of the patients in the chemotherapy were
still alive compared with 45.3 percent in the surgery-only arm.

"Our study confirms that a dose-intense regimen like PELF, which showed
very promising results in advanced gastric cancer, is not effective in an
adjuvant setting," the authors write. Considering the negative results in
this trial and other recent adjuvant chemotherapy trials in gastric
cancer, the authors write, "Adjuvant chemotherapy alone remains a
controversial approach in operable gastric cancer."

In an accompanying editorial, Aiwen Wu, M.D., and Jiafu Ji, M.D., of the
Beijing Cancer Hospital and Institute in China discuss the conflicting
results obtained from recent trials that tested the value of chemotherapy
and radiation in localized gastric cancer.

Despite the inconsistency of the overall data, the editorialists conclude
that chemotherapy, radiation, or a combination of the two should be used
in patients with gastric cancer. "Surgery alone is no longer the standard
treatment for patients with resectable gastric cancer, independent of the
patient population or the practice location," they write.

Journal reference: Di Costanzo F, Gasperoni S, Manzione L, Bisagni G,
Labianca R, et al. Adjuvant Chemotherapy in Completely Resected Gastric
Cancer: A Randomized Phase III Trial Conducted by GOIRC. J Natl Cancer
Inst 2008; 100: 388 -- 398

Editorial reference: Wu A, Ji J. Adjuvant Chemotherapy for Gastric Cancer
or Not: A Dilemma? J Natl Cancer Inst 2008; 100:376-377
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* w w w .bccancer.bc.ca/PPI/TypesofCancer/Stomach/default.htm